A Revised View of the Dynamics, Physiology, and Treatment of Occlusion: A New Paradigm

Abstract

A new perspective is proposed regarding the functional dynamics of occlusion, the masticatory muscles, and mandibular placement. Each is analyzed on the basis of a new criterion: force. Stomatognathic function is represented as an ongoing equilibrium maintained between the three-dimensional set of individual occlusal forces and the three-dimensional set of bilateral muscle forces. Mandibular placement is of prime importance, mediating as it does between the two. The conclusion is drawn that occlusion and the muscles can correlate optimally with each other only when the mandible occupies its neuromuscular position (NMP), herein defined as that placement where muscle accommodation is at its absolute minimum. The conclusion is that only the muscles themselves are capable of establishing the NMP and that customary conventional technology is inadequate. A new technology, hydrostatics, is needed to create the special (not existing naturally) occlusal conditions essential to optimally integrating occlusion, mandibular placement, and muscles. Preliminary EMG data is offered in support of this conclusion.

Kronen en bruggen in relatie tot het occlusiesysteem

“…Onder andere door systematische literatuuronderzoeken is duidelijk geworden dat doorslaggevende feiten om deze theorieën te onderbouwen geheel of gedeeltelijk ontbreken, meestal omdat geen duidelijke oorzaak-gevolgrelaties kunnen worden aangegeven en een duidelijke dosis-responsrelatie ontbreekt (Pergamalian et al, 2003;Lerman, 2004;Racich, 2005;Niemi et al, 2006;Van 't Spijker et al, 2007;Lavigne et al, 2008;de Grandmont, 2012;Türp en Schindler, 2012;Creugers en Witter, 2012).…”

Applying neuromuscular techniques in the orthodontic setting

“…This habitual rest position is the most functional position for the patient's occlusion, as it minimises the energy required to move to a centric occlusion (CO). 25 In other words, the CNS controls and guides the mandible to a position in which swallowing (a semi-autonomic physiological process) uses the least amount of energy possible given the physiological conformation present. The inter-occlusal space, or freeway space, is between 2 and 4 mm at length in the majority of the general population.…”

“…Thus, this first step involves evaluating the mandibular postural muscle function that is conditioned by occlusion (accommodation). 25 Periodontal stimuli sent to the CNS provide an active motor output signal as part of a feedback mechanism leading to the determination of the mandibular rest position. This habitual rest position is the most functional position for the patient's occlusion, as it minimises the energy required to move to a centric occlusion (CO).…”

“…Head posture is also adjusted to facilitate a mandibular trajectory free from premature occlusal contacts as the mandible moves to CO. 29 Although the CNS elaborates a habitual rest position that will reduce functional demands, it remains an accommodative response. 24,25 After obtaining detailed information about habitual function, the next step is to determine the mandibular posture and path of closure without occlusal conditioning. To do this, the periodontal afferent inputs to the CNS are interrupted, allowing relaxation of the mandibular postural muscles.…”

“…This "muscle memory" is the result of the physiologic demands of dental occlusion, and the implications it has on our social and biological function. 24,25 Analysis entails performing mandibular tracking during opening and closing of the lower jaw and during swallowing. Surface electromyography is then performed during mandibular rest, clenching, and movement.…”